Abstract
Spontaneous bacterial peritonitis (SBP) is a severe complication that occurs in 8-27% of hospitalized patients with liver cirrhosis and ascites, with high mortality rates. This study aimed to identify the clinical characteristics associated with SBP. Cross-sectional study, conducted in a public university. The study consecutively included individuals with liver cirrhosis and ascites between September 2009 and March 2012. Forty-five patients were included: mean age 53.2 ± 12.3 years, 82.2% male, 73.8% Caucasian, mean Model of End-stage Liver Disease (MELD) score of 19.5 ± 7.2, and 33.3% with SBP. The subjects were divided into two groups: SBP and controls. Comparison between individuals with SBP and controls showed that those with SBP had lower mean prothrombin activity time (36.1 ± 16.0% versus 47.1 ± 17.2%; P = 0.044) and lower median serum-ascites albumin gradient (SAAG) (1.2 versus 1.7, P = 0.045). There was a tendency towards higher mean MELD in the SBP group, not significant (22.2 ± 7.6 versus 17.9 ± 6.7; P = 0.067). There was a strong positive correlation between the neutrophil count in ascitic fluid and serum leukocyte count (r = 0.501; P = 0.001) and a negative correlation between the neutrophil count in ascitic fluid with prothrombin activity time (r = -0.385; P = 0.011). A few characteristics are associated with the presence of SBP, especially liver dysfunction, SAAG and peripheral leukocytosis.
Highlights
Spontaneous bacterial peritonitis (SBP) is found in 8% to 27% of the patients hospitalized with liver cirrhosis and ascites, and presents high rates of intra-hospital mortality, of between 20 and 40%.1-3 Studies have suggested that the recurrence rates are high: more than 70% within one year.4.5In the great majority of the cases, the bacteria that cause SBP come from the digestive tract
The following clinical variables were studied: age; gender; skin color; SBP; jaundice; hepatic encephalopathy; upper gastrointestinal bleeding (UGIB) during hospitalization; ascitic fluid cultures; maximum axillary temperature; abdominal pain; diarrhea; comorbidities: diabetes mellitus (DM), systemic arterial hypertension (SAH), dyslipidemia and HIV; etiology of the cirrhosis: alcohol, hepatitis C or hepatitis B; and duration of prophylactic antibiotics for paracentesis
From September 2009 to March 2012, 86 patients were evaluated for inclusion in the study because they presented decompensated cirrhosis with ascites and/or positive results from ascitic fluid cultures in the laboratory
Summary
Spontaneous bacterial peritonitis (SBP) is found in 8% to 27% of the patients hospitalized with liver cirrhosis and ascites, and presents high rates of intra-hospital mortality, of between 20 and 40%.1-3. In the great majority of the cases, the bacteria that cause SBP come from the digestive tract. Extra-intestinal bacteria, such as those from the respiratory and urogenital tracts or the skin, are much less frequent. The most accepted hypothesis regarding the pathogenesis of SBP consists of a bacteremia episode during fluid exchange between the peritoneal and intravascular cavities, with consequent infection of the ascitic fluid.[6] Aerobic Gram-negative bacteria (most frequently Escherichia coli) are considered responsible for the majority of SBP cases, through translocation of the intestinal lumen.[5,7]
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Schedule a callMore From: Sao Paulo medical journal = Revista paulista de medicina
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